Resiliency Intervention for Siblings of Children With Autism Spectrum Disorder: A Randomized Pilot Trial

BACKGROUND /OBJECTIVES

Neurotypical siblings (NT siblings) of children with autism spectrum disorder (ASD) are at elevated risk for emotional distress and adjustment problems. Resiliency is the ability to cope and adapt with ongoing stressors. We conducted a randomized waitlist-controlled pilot trial to examine the feasibility, acceptability, and preliminary efficacy of an adapted virtual mind-body resiliency group intervention for teen NT siblings of children with ASD.

METHODS

We modified the Stress Management and Resiliency Training-Relaxation Response Resiliency Program for NT siblings of children with ASD (SibChat). We randomly assigned teens (aged 14-17) to immediate intervention (IG) versus waitlist control (WLC). The intervention included eight 60-minute weekly video conference group sessions. We assessed feasibility (enrollment, attendance, and retention) and acceptability (post treatment survey and weekly relaxation response practice). We explored group differences in pre-post change scores for 1) stress coping (Measure of Current Status-A) and 2) resiliency (Current Experiences Scale) using independent samples t tests and effect size calculations.

RESULTS

We enrolled 83% of screened eligible teens. A total of 90% IG and 75% WLC participants attended at least 6/8 sessions. Among IG participants who completed the post treatment survey, 79% reported practicing relaxation response exercises at least "a few times a week". Comparing change in baseline to time 1, the IG showed better relative changes than the WLC group in stress coping (d = 0.60) and resiliency (d = 0.24).

CONCLUSIONS

Our pilot trial showed promising feasibility, acceptability, and preliminary efficacy of SibChat on at least one of the 2 primary outcomes supporting further testing of the SibChat intervention.

CLINICAL TRIAL REGISTRATION

US National Library of Medicine.

REGISTRATION NUMBER

NCT04369417. https://clinicaltrials.gov/ct2/show/NCT04369417.

Maintenance of Effects and Correlates of Changes Following Mindfulness for Interdisciplinary Health Care Professional Students

OBJECTIVES

To evaluate long-term outcomes after an 8-week mindfulness intervention, Mindfulness for Interdisciplinary Health Care Professionals (MIHP), and investigate relationships between outcomes overtime.

DESIGN/METHODS

In this single-arm study, 35 participants received MIHP and completed measures of burnout, perceived stress, activity impairment, and dispositional mindfulness at baseline, post-MIHP, and a 3-month follow-up. Changes over time were evaluated using repeated-measures analysis of variance (ANOVA) and reliable change indices (RCIs). Then, correlations between dispositional mindfulness and distress/impairment outcomes were evaluated.

RESULTS

At follow-up, aspects of burnout and several mindfulness skills demonstrated maintained improvements. RCIs showed that a higher percentage of participants improved on all outcomes at each time period than declined-all outcomes showed little to no deterioration. However, most participants did not reliably change, and this was more pronounced at the follow-up. Changes in two mindfulness skills (acting with awareness and nonjudging of inner experience) were consistently negatively correlated with distress and impairment outcomes.

CONCLUSIONS

Acquired mindfulness skills during MIHP were maintained at the follow-up. RCI analyses demonstrated that MIHP may protect against worsening stress and burnout during training. Two mindfulness skills, acting with awareness and nonjudging of inner experience, showed potential mechanistic effects on work-relevant outcomes. Booster sessions to encourage maintained mindfulness practices and skills should be investigated in future trials. This study was registered on clinicaltrials.gov (#NCT03403335) on January 11, 2018.

Effectiveness of a 4-Day Mindfulness-Based Intervention in a 2-Month Follow-Up for Chinese Incarcerated People

Mindfulness-based interventions, an evidence-based stress reduction approach, may help incarcerated people cope with stress-related problems in the challenging environment of prison. However, due to their unique living environment, the duration and instructor guidance required by standard mindfulness-based interventions would be infeasible in most prisons. Therefore, the aims of the current study were to test the effects of two different 4-day interventions (i.e., instructor-guided and audio-based) with content similar to Mindfulness-Based Cognitive Therapy for newly incarcerated males, and to compare the effectiveness of the two interventions relative to a no-intervention control group. Using daily assessments, we explored changes in perceived stress, insomnia, and negative affect in the 56 days following the instructor-guided (N = 25), audio-based (N = 21), and control (N = 44) intervention; length of mindfulness practice during the follow-up was also compared between the two intervention groups. Hierarchical linear model results showed significantly greater linear decreases in perceived stress after both mindfulness interventions during the 56-day follow-up (γ₁₁ = -0.011, p < .001, 95% CI [-0.017, -0.004] for instructor-guided intervention; γ₁₂ = -0.013, p < .001, 95% CI [-0.018, -0.006] for audio-based intervention), as compared to the control group. Compared to the control group, the instructor-guided group reported a significantly greater decrease in insomnia (γ₁₁ = -0.007, p < .001, 95% CI [-0.014, -0.002]), but the audio-based group did not (γ₁₂ = -0.002, p = .160, 95% CI [-.007, .004]). Neither mindfulness-based intervention group reported a significantly greater decrease in negative affect compared to the control group (γ₁₁ = -0.002, p = .170, 95% CI [-0.005, 0.001] for instructor-guided intervention; γ₁₂ = -0.002, p = .150, 95% CI [-0.006, 0.002] for audio-based intervention). No significant difference between the two intervention groups was found in the change of outcomes (γ₁₁ = 0.002, -0.005 and 0.000, p = .350, .130 and .390, 95% CI [-0.008, 0.011], 95% CI [-0.014, 0.004] and 95% CI [-0.004, 0.006] subsequently for perceived stress, insomnia and negative affect). Daily mindfulness practice was significantly longer for the audio-based group on the first day of follow-up (γ₀₂ = -0.758, p < .05, 95% CI [-1.333, -0.129]), but it gradually decreased to the same amount as the instructor-guided group (t (32) = 0.051, p = .959). Short-term mindfulness interventions, either instructor-guided or audio-based, appear to be beneficial for Chinese prisoners in reducing stress. Live instruction may have potential benefit in reducing insomnia and sustaining daily practice.

Relationship between adverse childhood experiences and anxiety symptoms among Chinese adolescents: The role of self-compassion and social support

Previous studies have revealed that adverse childhood experiences (ACEs) create a significant and lasting effect of increased anxiety. However, few studies have examined the mediating and moderating mechanisms underlying this relation. The present study aimed to explore the mediating role of self-compassion and moderating role of social support in ACEs-anxiety relationship among Chinese adolescents. In this cross-sectional study, 1,764 middle school students completed questionnaires measuring their levels of ACEs, anxiety, self-compassion (SC), and social support. Correlations of variables were computed using Pearson's r. Mediation and moderated mediation models were tested using PROCESS macro with the regression bootstrapping method. After covariates (age and gender) were controlled, results showed that: (1) ACEs were positively associated with anxiety symptoms; (2) self-compassion partially mediated the ACEs-anxiety association; (3) both ACEs-anxiety and SC-anxiety relationships were moderated by social support. Specifically, social support was associated with lower anxiety, particularly among students with fewer ACEs or lower level of self-compassion. Reducing possible adversities existing in environment may help to reduce risk of anxiety for adolescents. Cultivating self-compassion is crucial for adolescents' mental health, since it may play a role in ACEs-anxiety relationship. Social support would operate as a buffer to ACEs in the relation with anxiety, under the circumstances of mild adversities, and a promoter to self-compassion in the relation with anxiety, under the circumstances of low self-compassion.

Validation of the Chinese Version of Relaxation Sensitivity Index: A Tool for Predicting Treatment Effect in Mindfulness Interventions

Background: The Relaxation Sensitivity Index (RSI) measures relaxation-related fears developed and validated in western samples. The RSI captures three facets of fear regarding relaxation: physical, cognitive, and social concerns. This study aimed to translate and identify the factor structure of the Chinese version of the RSI. Methods: In a preliminary study, 26 items were generated mainly by translation and modified from the original RSI. In Study 1, factor analysis and internal consistency reliability analysis were conducted on separated half samples of 597 Chinese college students. In Study 2, test-retest reliability, convergent, and predictive criterion validity were examined based on 465 Chinese college students. Results: Fourteen items were selected based on the factor loading and item prevalence in the preliminary study. Factor analysis based on Study 1 identified three factors: Social appealing, Social performance, and Physical concerns. In general, the RSI demonstrated good internal consistency (αs = 0.750-0.860), convergent validity and predictive criterion validity, while the test-retest reliability is relatively low (rs = 0.525-0.685). Notably, less related to the other two factors, Social performance concerns may be a unique factor solely predicting social anxiety (p <0.001), but not relaxation-induced anxiety (p = 0.442). Conclusion: The Chinese version of the RSI possesses a factor structure different from the western population. The robustness of factor structure and test-retest reliability was not as good as expected. Further research is warranted to explore the validity of the RSI in Chinese samples.

Acceptability of a Virtual Mind-Body Intervention for Parents of Children With Autism or Learning Disabilities

Objective

Parents of children with learning/attentional disabilities (LAD) and autism spectrum disorder (ASD) are at elevated risk for chronic stress. Types of stress and treatment needs differ between these parent groups. We adapted our evidence-based mind–body intervention (SMART-3RP) for parents of children with LAD and ASD, delivered via videoconferencing. Preliminary results from our two wait-list randomized pilot trials suggest the programs were feasible and efficacious. To gain an in-depth understanding of acceptability, the purpose of this secondary analysis from the RCTs is to (1) explore feedback regarding the virtual SMART-3RP and (2) compare feedback across LAD and ASD parents.

Methods

Participants were randomized to immediate or delayed SMART-3RP (separate groups for LAD and ASD) and completed a feedback questionnaire post-intervention (N = 33 LAD, N = 37 ASD; 93% female, 93% white, Mage = 45.52, SD = 6.50).

Results

Participants reported the intervention had the right number of sessions (69%), session duration (83%), and amount of structure (83%). They felt comfortable during sessions (89%) and found mind–body skills helpful (89%). There were no significant differences between parent groups other than a trend for more ASD parents reporting sessions were too long (22% ASD vs. 6% LAD, X² = 5.67, p =0.06). Qualitative themes were similar across parents and included that video delivery had some technical challenges but enabled participation; group support and mind–body skills were helpful; and further SMART-3RP sessions or therapy is needed.

Conclusion

LAD and ASD parents found a synchronous video-based mind–body resiliency program acceptable. Technology limitations notwithstanding, online delivery was very satisfactory and overcame obstacles to participation.

Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress

PURPOSE

Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress.

METHODS

This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups.

RESULTS

Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers.

CONCLUSIONS

Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.

Moderators of a resiliency group intervention for frontline clinicians during the COVID-19 pandemic

BACKGROUND

To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP.

METHODS

102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping.

RESULTS

Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-Rfocus: 1.0 [0.4 to 1.6]; CAMS-Raccept: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping.

DISCUSSION

Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).

Examining the effects of stress and psychological distress on smoking abstinence in cancer patients

INTRODUCTION

Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence.

METHODS

Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6 months. Abstinence was biochemically-confirmed at 6 months. A subset of patients (n = 72) completed qualitative exit-interviews.

RESULTS

Patients were on average, 58 years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group × time interactions or main effects of treatment group on stress or distress measures (p's > 0.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p's < 0.05). In adjusted logistic regression models, lower levels anxiety at 3 months predicted confirmed smoking abstinence at 6 months (p = .03). Qualitatively, at 6 months, patients reported their stress and smoking were connected and that the cessation counseling was helpful.

CONCLUSIONS

Cancer patients enrolled in a smoking cessation trial report decreases in stress, distress and anxiety over time, and anxiety symptoms may impact smoking cessation success at follow-up resulting in an important intervention target.

Smokers with and without Epilepsy show Similar Smoking Rate, Dependence Level, Cessation Attempts, and Motives

BACKGROUND

Individuals with epilepsy are up to twice as likely to be current cigarette smokers compared to those without. Moreover, one study showed current smoking is associated with an increased likelihood of seizures. However, outside of this one study, there is limited data on the presentation of specific smoking-related behaviors and cognitions in people with epilepsy, inhibiting our understanding of the severity of this behavior and our ability to formulate effective treatments for this population.

PURPOSE

The current study examined smoking-related behaviors and cognitions among smokers with epilepsy compared to smokers without epilepsy.

METHODS

Participants were 43 smokers with (Mage = 43.4, SD = 11.6) and 43 smokers without (Mage = 45.5, SD = 8.8) epilepsy recruited from an urban, academic setting within the U.S. Separate Analyses of Covariance (ANCOVAs) were conducted to evaluate differences between smokers with and without epilepsy in terms of smoking behavior (i.e., daily smoking rate, nicotine dependence, number of quit attempts, smoking duration, age of smoking onset) and smoking-related cognitive processes (i.e., smoking motives, perceived barriers to smoking cessation, cessation motives) after controlling for race and problematic alcohol use.

RESULTS

Smokers with epilepsy did not differ from smokers without epilepsy in terms of smoking rate (p = .51, ηp2 = .01), nicotine dependence (p = .12, ηp2 = .03), age of smoking onset (p = .42, ηp2 = .01), number of quit attempts (p = .43, ηp2 = .01), barriers to cessation (p = .30 to .80, ηp2 = .00 to .01), or cessation motives (p = .28 to .60, ηp2 = .00 to .02). Smokers without epilepsy reported higher levels of smoking for sensorimotor manipulation reasons (p = .03, ηp2 = .06) and longer smoking duration (p = .03, ηp2 = .06) than smokers with epilepsy.

CONCLUSIONS

Smokers with epilepsy do not appear to differ significantly from smokers without epilepsy in terms of smoking-related behaviors and cognitions, and may therefore benefit from current evidence-based treatments for smoking cessation that are not contraindicated for epilepsy (i.e., bupropion, varenicline).

Development and Initial Validation of the Relaxation Sensitivity Index

Relaxation sensitivity indexes the fear of relaxation-related events. The purpose of this study was to develop and provide initial validation of a self-report measure of relaxation sensitivity, the Relaxation Sensitivity Index (RSI). Three independent samples of undergraduate students (n=300 unselected, n=349 non-clinical, and n=197 clinical analogs with elevated anxiety/depression symptoms) completed self-report measures to examine the factor structure, reliability, and validity of the RSI. Results of exploratory and confirmatory factor analyses supported a three-factor structure (correlated Physical, Cognitive, and Social Concerns). The RSI demonstrated good internal consistency and construct validity as evidenced by expected correlations with measures of anxiety and depression symptoms. The RSI showed good predictive validity in terms of a history of fearful responding to relaxation. RSI scores were significantly higher in the symptomatic compared to non-clinical sample. Results suggest the RSI is a valid and reliable measure that may be useful in clinical and research settings.

A Comprehensive Resiliency Framework: Theoretical Model, Treatment, and Evaluation

BACKGROUND

There is heterogeneity in conceptualizations of resiliency, and there is, to date, no established theoretically driven resiliency assessment measure that aligns with a targeted resiliency intervention. We operationalize resiliency as one's ability to maintain adaptive functioning in response to the ongoing, chronic stress of daily living, and we use a novel resiliency measure that assesses the target components of an evidence based resiliency intervention. We present our resiliency theory, treatment model, and corresponding assessment measure (Current Experience Scale; CES).

METHODS

To establish the psychometric properties of the CES, we report the factor structure and internal consistency reliability (N = 273). Among participants in our resiliency intervention (N = 151), we explored construct validity in terms of associations with theoretical model constructs, a validated resiliency measure, and sensitivity to change from before to after the intervention.

RESULTS

Results indicated that a 23-item, 6-factor solution was a good fit to the data (RMSEA = .08, CFI = .97; TLI =.96) and internal consistency was good (α = .81 to .95). The CES showed correlations in the expected direction with resiliency model constructs (all p's < .001) and significant post intervention improvements.

CONCLUSION

Our resiliency theory, treatment model, and outcome appear aligned; the CES demonstrated promise as a psychometrically sound outcome measure for our resiliency intervention and may be used in future longitudinal studies and resiliency building interventions to assess individuals' resiliency to adapt to ongoing stress.

Stress and Coping Among Health Professions Students During COVID-19: A Perspective on the Benefits of Mindfulness

Many health professions students experience elevated stress and burnout during their professional education and training. With the added challenges of COVID-19, students face a whole new set of stressors. Students in the Spring 2020 semester of our online academic course, "Mindfulness for Healthcare Providers," began confronting the COVID-19 crisis after several weeks of mindfulness meditation practice as part of the course. Students discussed their experiences using the course discussion boards, providing a unique opportunity to explore the practical application of mindfulness for student well-being during a crisis. Themes from the discussion board revealed a range of novel stressors and concerns due to COVID-19 (physical health, mental health, societal implications, academic and clinical training disruptions). All students reported that mindfulness practice helped them cope by improving specific mindfulness skills (focus, appreciation, cognitive de-centering, non-reactivity). Mindfulness training may be a useful approach to promoting student well-being during a crisis.

Responding to COVID-19 Stress: Disseminating Mind-Body Resiliency Approaches

The COVID-19 pandemic has resulted in unprecedented stress and uncertainty, particularly among vulnerable populations such as healthcare workers who are facing a multitude of current and looming economic and psychosocial stressors. As clinician-scientists delivering mind-body interventions in our hospital, we suggest applying evidence-based mind-body techniques that promote resiliency and adaptive coping during these difficult times. Interventions that package a variety of mind-body skills into one cohesive program, such as the Stress Management and Resiliency Training - Relaxation Response Resiliency Program (SMART-3RP), offer promise for meeting the variety of stress management needs (e.g., health concerns, isolation) present during the COVID-19 pandemic. From our work with frontline healthcare clinicians and other caregiver populations, we offer recommendations for adapting the delivery, modality, and content of mind-body practices during the COVID-19 pandemic and suggest key skills for promoting resiliency and buffering against the future stressors that lie ahead for everyone.

Exploring correlates of improved depression symptoms and quality of life following tai chi exercise for patients with heart failure

AIMS

Tai chi exercise has been shown in a prior randomized controlled trial to improve depression symptoms and quality of life (QoL) in patients with heart failure (HF), but correlates of these improvements are not well known. The purpose of this secondary analysis was to explore whether tai chi is associated with improvements in biopsychosocial and behavioural measures and whether such improvements are correlated with improved depression and QoL.

METHODS AND RESULTS

Participants were n = 100 adults with chronic systolic HF (mean age = 67.4, SD = 12.0; 64% male; 96% White; New York Heart Association class = 1-3) randomized to a 12 week tai chi exercise intervention or health education control. Constructs of interest included social support, exercise self-efficacy, activity engagement, sense of coherence, and inflammatory biomarkers. Tai chi was associated with increased everyday activity engagement compared with the health education group (P < 0.05), but there were no group differences in social support or sense of coherence. Among tai chi participants, improved self-efficacy was correlated with QoL (r = 31, P = 0.05), and there was a trend toward improved depression symptoms and social support (r = -0.22, P = 0.13). Among all participants, controlling for intervention group, improved sense of coherence, and inflammation (C-reactive protein) were associated with improved depression symptoms, and improved self-efficacy, sense of coherence, and frequency of activity engagement were associated with improved QoL.

CONCLUSIONS

Tai chi exercise promotes inter-related psychosocial improvements for patients with HF. A range of biopsychosocial and behavioural variables are relevant to mood management in patients with HF.

Feasibility and Acceptability of a Community-Based Modified Mindfulness-Based Stress Reduction Program for the Under- and Unemployed

Background

Mindfulness-Based Stress Reduction (MBSR) often improves health outcomes, though literature primarily focuses on middle-class, employed individuals. With an estimated average of six million unemployed over the past year, and the recent uptick in unemployment due to the COVID-19 pandemic, it is important to identify methods to mitigate and reduce the negative health outcomes often associated with under- and unemployment.

Objectives

We aimed to 1) outline the process of partnering with a community organization to implement a modified MBSR program for under- and unemployed individuals, and 2) present pilot data on preliminary results.

Methods

The modified MBSR program was implemented in two phases within a job training program for under- and unemployed individuals. In Phase I, group one received an eight-week program. Based on feedback, the MBSR program was reduced to six weeks and implemented for groups two and three (Phase II). Feasibility and acceptability were evaluated utilizing a mixed-methods approach. Changes in mindfulness, perceived stress, pain interference, anxiety, depression, and sleep disturbance were assessed pre-post the modified MBSR program.

Results

Thirty-three participants completed the program with twenty-nine post-survey responses. The modified MBSR program was feasible and acceptable as evidenced by the enrollment rate (96%), retention rate (72%), and qualitative feedback. Fifty-percent of participants self-reported weekly home practice compliance. Perceived stress and mindfulness demonstrated significant moderate improvements (d = .69, p = .005; d = .46, p = .001). Depression, anxiety, and pain interference results suggested small non-significant effect size improvements (d = .27, p = .19; d = .23, p = .31; d = .25, p = .07). Effects on fatigue and sleep disturbance were negligible.

Conclusion

The modified MBSR program was feasible and acceptable to the organization and participants. Small to moderate improvements in mental health and pain interference outcomes were observed. Research using larger sample sizes and randomized designs is warranted.

A Virtual Resiliency Intervention for Parents of Children with Autism: A Randomized Pilot Trial

Parents of children with Autism experience high levels of stress. Resiliency is the ability to cope and adapt when faced with stressful events. This randomized, waitlist controlled pilot trial examines the feasibility, acceptability, and preliminary efficacy of an adapted virtual mind-body group intervention for parents of children with ASD. The intervention was feasible and acceptable. The immediate treatment group showed no difference in distress and greater improvement in resiliency and stress reactivity/coping relative to the delayed treatment group, (M difference 5.78; p = .038 and M difference 7.78; p = .001 respectively). Findings showed promising feasibility, acceptability, and preliminary efficacy for parents of children with ASD.

A systematic review and meta-analysis of mindfulness- and acceptance-based interventions for affect intolerance/sensitivity

Affect intolerance/sensitivity, defined as one's sensitivity to, or inability to tolerate, affective states, is a transdiagnostic process implicated in the development and maintenance of numerous forms of psychopathology. Mindfulness and acceptance interventions are posited to improve affect intolerance/sensitivity; however, there has been no quantitative synthesis of this research to date. Seven electronic databases were searched up until November 2018. Hedges' g values, 95% confidence intervals, p-values, and Q-values were calculated for a series of random-effects models. Twenty-five studies (pooled N = 1778) met eligibility criteria and were included in the qualitative synthesis (n = 22 included in the meta-analysis). There was a small, significant effect of mindfulness and acceptance interventions on improving affect intolerance/sensitivity from pre-to post-intervention (Hedges' g = -0.37, 95% CI = -0.52 to -0.23, p < .001), with effects maintained up to 6-months (Hedges' g = -0.35, 95% CI = -0.61 to -0.09, p < .01). There was a significantly larger effect for studies with inactive compared to active controls. No significant effect size differences were found for intervention length (<8 vs. ≥ 8 sessions), intervention type (mindfulness vs. acceptance) or sample type (clinical vs. non-clinical). Mindfulness and acceptance interventions modestly improve affect intolerance/sensitivity.

A Perspective on the Similarities and Differences Between Mindfulness and Relaxation

Mind-body medicine is an evidence-based approach to health and healing that focuses on interactions between the mind, body, and behavior. It encompasses a wide range of interventions that are similar yet different in meaningful ways. Mindfulness and relaxation practices are 2 mind-body techniques that have similarities and differences; however, these techniques are often used or discussed interchangeably, such that the differences between them become obscured. A greater understanding of the unique facets of mindfulness and relaxation is needed for researchers and clinicians to make informed decisions when selecting an approach. The purpose of the current article is to offer an evidence-informed perspective on similarities and differences between mindfulness and relaxation. Specifically, mindfulness and relaxation practices are compared and contrasted in terms of theoretical foundation, intention, and psychological and physiological effects and mechanisms. Implications for clinical practice and suggestions for future research are discussed.

Theoretical Rationale and Case Illustration of Mindfulness-Based Cognitive Therapy for Fear of Cancer Recurrence

Fear of cancer recurrence (FCR) is a common problem among cancer survivors and evidence-based interventions grounded in theoretical models are needed. Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based intervention for reducing health anxiety that could be useful to apply to FCR. However, there has only been one study of MBCT for FCR to date, and the theoretical rationale and practical application of MBCT for FCR has not been described. The purpose of this paper is to offer an evidence-based rationale for MBCT to treat FCR based on a health anxiety model; describe the process of adapting MBCT to target FCR; and present a case study of the adapted protocol for treating FCR in a young adult breast cancer survivor to illustrate its delivery, feasibility, acceptability, and associated changes in outcomes. Clinical implications and directions for future research are discussed.

The indirect effect of positive affect in the relationship between trait mindfulness and emotion dysregulation

Mindfulness is correlated with better emotion regulation and mindfulness training improves emotion regulation; however, mechanisms of these effects have not been widely studied. Therefore, the aim of the current study was to examine the indirect effect of greater mindfulness on fewer emotion regulation difficulties through positive affect. Participants were 219 undergraduate students (M _age =19.20; 70.5% female; 91.5% Caucasian) who completed self-report measures for course credit. Results indicated a significant direct effect of mindfulness on emotion dysregulation (b = -1.71, t = -6.94, p < .001) and significant indirect effect of greater mindfulness on fewer emotion regulation problems through higher levels of positive affect (indirect effect =-0.50; SE = 0.13; 95% CI = -0.80 to -0.28). These results help to generate testable hypotheses for future mechanistic research in this area by suggesting that one way trait mindfulness may protect against emotion dysregulation could be by cultivating positive affect. Future research using longitudinal designs is needed to explore positive affect as a causal mechanism.

Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis

OBJECTIVE

Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR.

METHODS

Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models.

RESULTS

Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed postintervention (Hedges' g = -0.36, 95% CI = -0.49, -0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance.

CONCLUSIONS

Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

BACKGROUND AND OBJECTIVES

Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

METHODS

Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit.

RESULTS

Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

CONCLUSIONS

These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.

A brief facial morphing intervention to reduce skin cancer risk behaviors: Results from a randomized controlled trial

The current study was designed to test the efficacy of an appearance-based facial morphing program to reduce intentional UV exposure among individuals at risk for skin cancer. A three-arm randomized controlled trial was employed (N = 219) comparing facial morphing + health information to: (1) mindfulness + health information; and (2) health information only. Participants were young adults with a history of recent intentional tanning and future intentions to tan. Primary outcomes were indoor and outdoor tanning frequency and tanning intentions, with secondary outcomes of tanning attitudes, body image, and affect. Facial morphing participants reported less frequent tanning, compared to mindfulness and control participants at 1-month follow-up. Facial morphing participants also generally reported lower intentions to tan at immediate follow-up, although the magnitude of these effects weakened at 1-month follow-up. Facial morphing programs may offer a brief, efficacious, and scalable augmentation to standard of care in reducing intentional UV exposure. This trial is registered with clinicaltrials.gov (NCT03237013).

Characteristics of adult smokers presenting to a mind-body medicine clinic

Mind-body interventions can improve vulnerabilities that underlie smoking behavior. The characteristics of smokers who use mind-body medicine have not been explored, preventing the development of targeted interventions. Patients ( N = 593) presenting to a mind-body medicine clinic completed self-report measures. Patients were 67 percent never smokers, 27 percent former smokers, and 6 percent current smokers. Current smokers were younger; more likely to be single, unemployed, or on disability; and report greater depression symptoms, greater pain, and lower social support ( ps < .05).Current smokers who use mind-body medicine have unique psychosocial needs that should be targeted in mind-body smoking cessation interventions.

Project reach: Piloting a risk-tailored smoking cessation intervention for lung screening

The purpose of this study was to explore the feasibility, acceptability, and efficacy of a telephone-based smoking cessation intervention for lung screening patients. Participants (N = 39) were enrolled in a single-arm pilot study of a four-session telephone-based intervention. Self-report measures were completed at baseline, post-intervention, and 3-month follow-up. Participants were long-term smokers; 62 percent were not motivated to quit. Twenty-three percent attempted quitting, 29 percent decreased their smoking, and 11 percent reported abstinence. Confidence increased (p < .001) and there were trends toward increased importance (p = .09) and comparative disease risk (p = .02). This intervention was acceptable and associated with improvements in smoking-related beliefs and behaviors.

The effects of a brief mindfulness exercise on state mindfulness and affective outcomes among adult daily smokers

Brief, single session mindfulness training has been shown to reduce emotional distress, craving, and withdrawal symptoms among smokers when they are nicotine-deprived. However, no research has examined the efficacy of brief mindfulness training for non-nicotine-deprived smokers, or explored its effects on smokers' ability to tolerate emotional distress. Smokers progress differently through various stages as they attempt to change their smoking behavior and evidence-based strategies are needed for smokers at all levels of nicotine deprivation. Therefore, the purpose of the current study was to examine the effects of a brief mindfulness exercise on state mindfulness, distress, distress tolerance, and smoking urges following a distressing laboratory task among 86 non-nicotine-deprived adult daily smokers (M_age=46years, 55% male, 74% African-American) who completed behavioral tasks and self-report measures before and after randomization to a 10-min mindfulness or control exercise. As hypothesized, the mindfulness exercise significantly increased state mindfulness [F=14.24, p=0.00, η²_partial=0.15] and demonstrated a non-significant small to medium effect on decreased distress levels [F=3.22, p=0.08, η²_partial=0.04]. Contrary to prediction, it was not associated with improvements in self-reported [F=2.68, p=0.11, η²_partial=0.03] or behavioral distress tolerance [F(1)=0.75, p=0.39, η²_partial=0.01], or smoking urges following a stressor [F=0.22, p=0.64, η²_partial=0.00.] These findings suggest that brief mindfulness exercises successfully induce states of mindfulness in non-nicotine-deprived smokers. These exercises might also improve current moment levels of distress, but they do not appear to improve self-report or behavioral indices of distress tolerance.

A Systematic Review and Meta-analysis of the Effects of Meditation on Empathy, Compassion, and Prosocial Behaviors

Increased attention has focused on methods to increase empathy, compassion, and pro-social behavior. Meditation practices have traditionally been used to cultivate pro-social outcomes, and recently investigations have sought to evaluate their efficacy for these outcomes. We conducted a systematic review and meta-analysis of meditation for pro-social emotions and behavior. A literature search was conducted in PubMed, MEDLINE, PsycINFO, CINAHL, Embase, and Cochrane databases (inception-April 2016) using the search terms: mindfulness, meditation, mind-body therapies, tai chi, yoga, MBSR, MBCT, empathy, compassion, love, altruism, sympathy, or kindness. Randomized controlled trials in any population were included (26 studies with 1,714 subjects). Most were conducted among healthy adults (n=11) using compassion or loving kindness meditation (n=18) over 8-12weeks (n=12) in a group format (n=17). Most control groups were wait-list or no-treatment (n=15). Outcome measures included self-reported emotions (e.g., composite scores, validated measures) and observed behavioral outcomes (e.g., helping behavior in real-world and simulated settings). Many studies showed a low risk of bias. Results demonstrated small to medium effects of meditation on self-reported (SMD = .40, p < .001) and observable outcomes (SMD = .45, p < .001) and suggest psychosocial and neurophysiological mechanisms of action. Subgroup analyses also supported small to medium effects of meditation even when compared to active control groups. Clinicians and meditation teachers should be aware that meditation can improve positive pro-social emotions and behaviors.

Postpartum Outcomes and Formal Mindfulness Practice in Mindfulness-Based Cognitive Therapy for Perinatal Women

Anxiety is common during pregnancy and associated with poorer outcomes for mother and child. Our single-arm pilot study of an eight-week Mindfulness-Based Cognitive Therapy (MBCT) intervention for pregnant women with elevated anxiety showed significant pre- to post-intervention improvements in anxiety, depression, worry, mindfulness, and self-compassion. It remains unclear whether these improvements are maintained post-partum and whether amount of formal mindfulness practice is correlated with outcomes. The current study examined whether 1) improvements in psychosocial outcomes were maintained three months postpartum; 2) women were adherent to formal practice recommendations; and 3) amount of mindfulness practice was correlated with outcomes. Twenty-three pregnant women (M_age=33.5, SD=4.40; 75% White; 71% with Generalized Anxiety Disorder) completed home practice logs throughout the intervention, and self-report measures before and after the intervention and three months postpartum. Results indicated that previously reported post-intervention improvements in anxiety, worry, mindfulness, and self-compassion were maintained postpartum (p's<.05), and reductions in depression further improved (p<.001). Participants were generally adherent to mindfulness practice recommendations during the intervention (54%-80% weekly adherence; M=17.31 total practice hours [SD=7.45]), and many continued practicing one-week post-intervention (91%) and postpartum (55%). Mindfulness practice during the intervention was not significantly correlated with any outcome at post-intervention or postpartum. Mindfulness practice postpartum was only marginally related to improved worry postpartum (p=.05). MBCT may be associated with maintained improvements in psychosocial outcomes for women during pregnancy and postpartum, but the role of mindfulness practice is unclear. Research using larger samples and randomized controlled designs is needed.

Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults

Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.

Feasibility, Acceptability, and Preliminary Effectiveness of a 4-week Mindfulness-Based Cognitive Therapy Protocol for Hospital Employees

Hospital employees may experience occupational stress and burnout, which negatively impact quality of life and job performance. Evidence-based interventions implemented within the hospital setting are needed to promote employees' well-being. We offered a 4-week Mindfulness-Based Cognitive Therapy group program for hospital employees, and used a mixed-methods practice-based research approach to explore feasibility, acceptability, and effects on stress and burnout. Participants were 65 hospital employees (M_age = 44.06; 85% white) who participated between September 2015 and January 2016. Participants completed validated measures of stress and burnout before and after the program, and answered open-ended satisfaction questions after the program. Groups consistently enrolled at least 10 participants, but attendance rates declined across sessions (76% at session 2 vs. 54% at session 4) due primarily to work-related scheduling conflicts. The program content was acceptable as evidenced by high perceived value (M = 9.18 out of 10), homework compliance (51% practicing at least 3 times/week), and qualitative requests for program expansion. There were large, statistically significant decreases in stress (ΔM = 2.1, p < .001, d = .85) and medium decreases in burnout (ΔM = .46, p = .01, d = .57), which were supported by qualitative themes of improved self-regulation and mindfulness skills, stress reduction, emotional well-being, and improved work productivity and patient care skills. Findings suggest that 4-week MBCT is acceptable and useful for hospital employees, though research is needed to identify alternate delivery methods or strategies to enhance session attendance.

Stigmatic and Sympathetic Attitudes Toward Cancer Patients Who Smoke: A Qualitative Analysis of an Online Discussion Board Forum

INTRODUCTION

A significant minority of patients continue to smoke after a cancer diagnosis. Cancer patients who smoke experience stigma that can negatively impact health outcomes. We explored publicly shared perspectives about cancer patients who continued to smoke post-diagnosis.

METHODS

An online news article, published in January 2012, summarized the findings of smoking prevalence among patients with lung cancer and colorectal cancer enrolled in the Cancer Care Outcomes Research and Surveillance Consortium trial. In response, written comments were posted on the articles' public discussion board. Applying principles of grounded theory, we conducted a document analysis and established a conceptual framework to develop a model by which to explain factors underlying stigmatic and sympathetic attitudes toward cancer survivors who continue to smoke.

RESULTS

Personal experiences with cancer, smoking, and statistical literacy were found to influence beliefs about cancer and smoking, which in turn influenced stigmatic or sympathetic attitudes. More sympathetic attitudes were expressed by individuals who had personal experiences with smoking, believed cancer is multicausal, identified smoking as an addiction, or considered extrinsic factors responsible for smoking. Individuals who did not have personal experiences with cancer or smoking, had low statistical literacy, believed that smoking necessarily and directly causes cancer, and focused on intrinsic responsibilities for smoking tended to express more stigmatic attitudes.

CONCLUSIONS

The current findings raise awareness and provide insight into stigma against cancer survivors who smoke and can help inform strategies for reducing stigma against this vulnerable group.

IMPLICATIONS

This study helps raise awareness of stigma toward cancer patients who smoke and provides insight into the processes that may influence stigmatic as compared to sympathetic attitudes toward these patients. Results suggest that population-based strategies to educate the public regarding the nature of nicotine addiction, difficulty of quitting, and benefits of quitting for cancer patients may be useful for reducing stigma against cancer patients with a smoking history.

Integrating tobacco treatment into thoracic oncology settings: Lessons learned

Clinical practice guidelines recommend tobacco treatment for all cancer patients. However, little is known about how to integrate tobacco treatment into cancer care. The results of our pilot study of an evidence-based tobacco treatment integrated into a thoracic oncology clinic demonstrated good feasibility and efficacy, providing an opportunity to inform future tobacco treatment integration efforts. Here, we describe the process of intervention development, clinic integration, patient identification, and patient enrollment. We report on the intervention content and delivery, patterns of quitting for participants in the tobacco treatment group, and changes in smoking-related psychosocial variables. Clinical implications and suggestions for future research are discussed.

Mindfulness-based cognitive therapy for youth with anxiety disorders at risk for bipolar disorder: a pilot trial

AIM

Children and adolescents with bipolar parents have an elevated risk for anxiety disorders. However, antidepressant medications commonly used to treat symptoms of anxiety may accelerate the onset of mania in these already at-risk youth. Therefore, studies evaluating innovative non-pharmacologic treatments for anxiety in this population are urgently needed.

METHODS

Subjects participated in 12 weekly sessions of mindfulness-based cognitive therapy for children (MBCT-C), a manualized group psychotherapeutic intervention utilizing cognitive behavioural principles and mindfulness exercises to increase regulation of attention and non-judgmental acceptance of present moment thoughts, emotions and experiences. Independent raters administered symptoms rating scales prior to each treatment session. Spearman correlations and paired-samples signed rank tests were used to examine outcomes. After-intervention surveys and session transcripts were reviewed to assess feasibility and acceptability of the intervention.

RESULTS

Participants included 10 youth (meanage  = 13.2; 80% girls; 40% biracial) with generalized, social and/or separation anxiety disorders, and a parent with bipolar disorder. Clinician-rated anxiety was significantly reduced after intervention (meanbefore  = 11.1; meanafter  = 4.3; P < 0.01), as well as youth-rated trait anxiety (P = 0.03). Parent-rated emotion regulation significantly increased from before to after intervention (P = 0.05). Increases in mindfulness were associated with decreases in anxiety (P = 0.03). Finally, children and parents/guardians reported high levels of feasibility, acceptability and usefulness of the intervention.

CONCLUSION

Findings support the feasibility, acceptability and preliminary efficacy of MBCT-C for treating anxiety in youth at risk for bipolar disorder. Future controlled and larger studies are needed to confirm these preliminary findings.

Neural Function Before and After Mindfulness-Based Cognitive Therapy in Anxious Adolescents at Risk for Developing Bipolar Disorder

OBJECTIVE

We sought to evaluate the neurophysiology of mindfulness-based cognitive therapy for children (MBCT-C) in youth with generalized, social, and/or separation anxiety disorder who were at risk for developing bipolar disorder.

METHODS

Nine youth (mean age: 13 ± 2 years) with a generalized, social, and/or separation anxiety disorder and a parent with bipolar disorder completed functional magnetic resonance imaging (fMRI) while performing a continuous processing task with emotional and neutral distractors (CPT-END) prior to and following 12 weeks of MBCT-C.

RESULTS

MBCT-C was associated with increases in activation of the bilateral insula, lentiform nucleus, and thalamus, as well as the left anterior cingulate while viewing emotional stimuli during the CPT-END, and decreases in anxiety were correlated with change in activation in the bilateral insula and anterior cingulate during the viewing of emotional stimuli (p < 0.05, uncorrected; p < 0.005 corrected; cluster size, 37 voxels).

CONCLUSIONS

MBCT-C treatment in anxious youth with a familial history of bipolar disorder is associated with increased activation of brain structures that subserve interoception and the processing of internal stimuli-functions that are ostensibly improved by this treatment.

Mind-Body Skills Training to Improve Distress Tolerance in Medical Students: A Pilot Study

PROBLEM

Medical students face rigorous and stressful work environments, resulting in high rates of psychological distress. However, there has been a dearth of empirical work aimed at modifying risk factors for psychopathology among this at-risk group. Distress tolerance, defined as the ability to withstand emotional distress, is one factor that may be important in promoting psychological well-being in medical students. Thus, the aim of the current mixed-methods study was (a) to describe changes in facets of distress tolerance (i.e., emotional tolerance, absorption, appraisal, regulation) for medical students who completed a mind-body skills training group, and a no-intervention control group of students; (b) to examine the relationship between changes in psychological variables and changes in distress tolerance; and (c) to report students' perceptions of the mind-body group, with an emphasis on how the group may have affected personal and professional functioning due to improvements in distress tolerance.

INTERVENTION

The mind-body program was an 11-week, 2-hour skills training group that focused on introducing, practicing, and processing mind-body skills such as biofeedback, guided imagery, relaxation, several forms of meditation (e.g., mindfulness), breathing exercises, and autogenic training.

CONTEXT

Participants were 52 first- and second-year medical students (62.7% female, Mage = 23.45, SD = 1.51) who participated in a mind-body group or a no-intervention control group and completed self-report measures before and after the 11-week period.

OUTCOME

Students in the mind-body group showed a modest improvement in all distress tolerance subscales over time (ΔM = .42-.53, p = .01-.03, d = .44-.53), whereas the control group showed less consistent changes across most subscales (ΔM = .11-.42, p = .10-.65, d = .01-.42). Students in the mind-body group qualitatively reported an improved ability to tolerate affective distress. Overall, improvements in psychological symptoms were associated with improvements in distress tolerance in the mind-body group but not in the control group.

LESSONS LEARNED

These preliminary findings provide support for the notion that improving distress tolerance through mind-body skills training might serve to protect medical students from becoming functionally impaired by psychological distress. Thus, implementing mind-body skills training into medical school education may help to improve the psychological well-being of medical students. Future studies utilizing more methodologically rigorous designs are warranted.

Anxiety Sensitivity and Reactivity to Asthma-Like Sensations Among Young Adults With Asthma

Anxiety sensitivity, particularly the physical concerns domain, is associated with more problematic asthma symptoms and greater functional limitations. It has been theorized that anxiety sensitivity fosters greater reactivity to asthma-related physical sensations; however, this theory has yet to be empirically tested. Thus, the present investigation sought to examine the role of anxiety sensitivity-physical concerns in terms of affective and physical reactivity to asthma-like symptoms. Participants were 101 undergraduates with asthma (76.2% female, Mage = 19.69 years, SD = 3.77 years, range = 18-49 years) who completed self-report measures and a straw-breathing task. Results indicated that after controlling for the effects of gender, asthma control (i.e., how well one's asthma symptoms are managed or controlled), and negative affectivity, greater levels of anxiety sensitivity-physical concerns significantly predicted greater anxiety (4.7% unique variance) and asthma symptoms (6.9% unique variance) and lower levels of lung function (4.4% unique variance) after the straw-breathing task. These findings suggest that individuals with asthma who are fearful of physiological arousal are a particularly "at-risk" population for poor asthma outcomes because of this greater reactivity and could benefit from interventions targeting anxiety sensitivity.

Integrative Care Therapies and Physiological and Pain-related Outcomes in Hospitalized Infants

Background:

Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting.

Objective:

The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcomes among hospitalized infants.

Methods:

We conducted a retrospective review of a clinical database from a level III NICU regularly delivering integrative care therapies. Paired-samples t-tests were used to examine associations between integrative care therapies and 4 pre-post outcome measures: therapist-rated pain and presentation (ranging from asleep to agitated) and neonates' heart rate and oxygen saturation.

Results:

Of 186 patients (M_age=68 days), 58% were male and 67% were Caucasian. Sixty-two percent received both massage and healing touch; the remainder received a single therapy. From pre-post therapy, statistically significant changes were observed in infants' heart rate (M_pre=156 vs M_post=140 per minute; P<.001), oxygen saturation (M_pre=95.0% vs.M_post=97.4%; P<.001), and therapist-reported pain (M_pre=2.8 vs M_post=0.2; P<.001) and presentation (M_pre=3.2 vs. M_post=1.0; P<.001).

Conclusion:

Observed improvements in pain-related outcomes suggest that massage and healing touch may be useful integrative therapies to consider as pain management options in the NICU.

Characteristics of postural control among young adults with asthma

OBJECTIVE

We investigated whether young adults with asthma have impaired balance and whether this impairment is related to altered musculoskeletal function and/or psychological characteristics.

METHODS

21 participants with a self-reported asthma diagnosis but no known postural instability or history of falls, and 18 control participants were recruited from undergraduate psychology courses. Participants performed a postural control task of maintaining the center of pressure (COP) in a fixed position with visual feedback (feedback condition) and while standing as still as possible without visual feedback (no-feedback condition). COP variability, regularity and task performance were used to characterize the quality of balance. To document group differences in musculoskeletal function, we measured neck and lower back angles as well as range of motion (ROM) of the neck in the frontal and sagittal planes. To document group differences in psychological state, we administered self-report questionnaires to assess symptoms of anxiety and depression, anxiety sensitivity and negative effect.

RESULTS

COP variability and task performance were similar between the groups, but participants with asthma exhibited more regular anterior-posterior COP dynamics. Participants with asthma had smaller ROM of neck extension, a more forwardly bent neck, greater thoracic spine angle, and they reported greater levels of the physical concerns facet of anxiety sensitivity. These musculoskeletal and affective variables moderated COP differences between the groups.

CONCLUSIONS

Young adults with asthma showed a different postural control strategy in the absence of any obvious balance impairment. This change in strategy is related to musculoskeletal and affective characteristics of individuals with asthma.

Distress tolerance and perceived barriers to smoking cessation

BACKGROUND

The present study examined the role of emotional distress tolerance (DT) in predicting barriers to smoking cessation and number of quit attempts.

METHODS

The sample consisted of regular daily smokers (N = 126; 37 females; M age = 36.51, SD = 13.05) who completed self-report measures on affect and smoking.

RESULTS

After controlling for daily smoking rate and anxiety sensitivity, emotional DT significantly predicted internal barriers to cessation (6.9% unique variance) but not external or addiction-related barriers to cessation. Inconsistent with prediction, emotional DT did not significantly predict number of quit attempts.

CONCLUSIONS

These results suggest that individuals who are low in emotional DT believe that quitting smoking will be difficult because it takes away an important affect regulation strategy, and there may be utility in targeting emotional DT in smoking cessation interventions.